Understanding trends and variation in paediatric fracture management in England

Sarah Lucas

26 June 2024

Aims


  1. Update and add to the information in the literature on the epidemiology/incidence rate of various paediatric fractures (toe, clavicle, wrist and elbow) in England.

  2. Understand the trends in management of these fracture types over time, e.g. have changes in guidance during COVID-19 changed the trends in management of fractures in Emergency departments.

  3. Investigate the variation in management of these fracture types between Trusts, and the potential activity and cost savings if there was more widespread conservative management, such as reducing unnecessary follow-ups appointments and manipulation in the Emergency Department rather than in theatre.

Fracture incidence rates


Annual fracture incidence rates per 100,000 (2023/2024)

Type

Female
0-4 yrs

Female
11-16 yrs

Female
5-10 yrs

Male
0-4 yrs

Male
11-16 yrs

Male
5-10 yrs

Total

Clavicle

129.9

62.0

76.3

130.7

248.0

152.6

134.8

Elbow

170.4

93.9

282.1

174.3

172.1

269.0

195.4

Forearm

272.4

484.1

829.8

274.4

1,261.0

859.7

702.6

Tibia/Fibula

172.4

70.4

71.4

211.2

170.4

76.2

123.7

Toe

16.9

158.6

124.2

25.5

278.0

140.8

134.2

Incidence rate by age/sex group

ICB fracture incidence rate by ICB area (2023/2024)

Incidence of upper limb fractures by ICB (2023/2024)

Incidence of lower limb fractures by ICB (2023/2024)

Table of incidence rates per 100,000 by ICB (2023/2024)

ICB

Clavicle

Elbow

Forearm

Tibia/Fibula

Toe

Total

NHS Cornwall and the Isles of Scilly Integrated Care Board

215.5

329.8

1,271.2

189.5

218.6

444.9

NHS Herefordshire and Worcestershire Integrated Care Board

190.2

288.1

1,108.0

134.7

245.1

393.2

NHS Gloucestershire Integrated Care Board

214.7

189.2

1,126.4

182.7

193.4

381.3

NHS Shropshire, Telford and Wrekin Integrated Care Board

188.1

270.0

993.0

131.3

211.2

358.7

NHS Dorset Integrated Care Board

183.0

263.5

988.6

138.2

192.9

353.2

NHS Somerset Integrated Care Board

189.5

260.7

966.8

134.7

162.6

342.8

NHS Staffordshire and Stoke-on-Trent Integrated Care Board

163.0

228.0

948.7

155.2

218.8

342.7

NHS South Yorkshire Integrated Care Board

168.6

271.1

935.1

150.1

178.2

340.6

NHS Lincolnshire Integrated Care Board

168.2

236.3

921.3

150.0

210.2

337.2

NHS Norfolk and Waveney Integrated Care Board

191.5

251.6

910.8

158.7

157.0

333.9

NHS Sussex Integrated Care Board

166.7

249.7

925.8

130.7

169.3

328.4

NHS Humber and North Yorkshire Integrated Care Board

195.0

221.3

867.3

139.3

170.7

318.7

NHS Devon Integrated Care Board

164.1

233.8

879.7

140.8

137.1

311.1

NHS Northamptonshire Integrated Care Board

172.9

227.0

805.9

127.2

170.4

300.7

NHS Nottingham and Nottinghamshire Integrated Care Board

150.4

240.0

801.7

152.2

156.3

300.1

NHS North East and North Cumbria Integrated Care Board

135.5

220.1

791.4

140.5

177.8

293.1

NHS Derby and Derbyshire Integrated Care Board

151.4

212.2

788.4

152.9

142.4

289.5

NHS Mid and South Essex Integrated Care Board

141.6

220.6

776.0

163.7

139.5

288.3

NHS Birmingham and Solihull Integrated Care Board

135.7

246.5

762.9

125.3

156.9

285.5

NHS Hampshire and Isle of Wight Integrated Care Board

138.8

230.2

780.4

142.3

129.4

284.2

NHS Black Country Integrated Care Board

131.6

261.3

765.9

123.9

124.6

281.4

NHS Greater Manchester Integrated Care Board

133.0

188.5

787.5

115.0

158.3

276.4

NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board

139.2

204.5

763.0

131.0

135.9

274.7

NHS Coventry and Warwickshire Integrated Care Board

153.8

188.4

745.2

133.3

141.2

272.4

NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board

131.4

235.6

728.4

105.5

151.2

270.4

NHS West Yorkshire Integrated Care Board

161.4

203.4

702.2

137.5

136.1

268.1

NHS Leicester, Leicestershire and Rutland Integrated Care Board

131.5

200.8

642.0

156.4

121.7

250.5

NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board

123.3

218.5

643.0

172.0

90.3

249.4

NHS Surrey Heartlands Integrated Care Board

143.0

171.0

645.0

137.0

143.9

248.0

NHS Cheshire and Merseyside Integrated Care Board

134.3

192.8

650.5

115.5

112.2

241.1

NHS Lancashire and South Cumbria Integrated Care Board

129.6

180.6

636.3

131.7

120.3

239.7

NHS Hertfordshire and West Essex Integrated Care Board

124.2

169.9

622.2

110.7

123.3

230.1

NHS Cambridgeshire and Peterborough Integrated Care Board

123.1

162.5

595.3

83.7

109.6

214.8

NHS Suffolk and North East Essex Integrated Care Board

129.1

143.7

553.1

101.4

116.0

208.7

NHS North Central London Integrated Care Board

96.0

141.1

520.7

105.2

104.1

193.4

NHS South West London Integrated Care Board

92.2

99.7

449.5

111.3

97.7

170.1

NHS Kent and Medway Integrated Care Board

87.1

102.7

487.4

62.2

107.6

169.4

NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board

96.3

134.9

443.1

82.5

59.0

163.2

NHS North West London Integrated Care Board

79.0

119.5

422.3

86.3

62.3

153.9

NHS Frimley Integrated Care Board

78.1

119.6

392.4

77.5

66.1

146.7

NHS South East London Integrated Care Board

63.9

100.2

323.3

79.0

65.3

126.3

NHS North East London Integrated Care Board

63.1

124.3

306.6

79.1

53.6

125.3

Most common fracture types (2023/2024)


SNOMED description

Number

Closed fracture of radius (disorder)

Forearm

47,711

Elbow fracture - closed (disorder)

Elbow

18,501

Closed fracture of radius AND ulna (disorder)

Forearm

17,382

Closed fracture of clavicle

Clavicle

15,166

Closed fracture of phalanx of foot (disorder)

Toe

15,091

Closed fracture of tibia (disorder)

Tibia/Fibula

8,506

Closed fracture scaphoid, waist, transverse (disorder)

Forearm

7,537

Closed fracture of ulna (disorder)

Forearm

4,293

Closed supracondylar fracture of humerus (disorder)

Elbow

3,360

Closed fracture of fibula (disorder)

Tibia/Fibula

3,259

Closed fracture of tibia AND fibula (disorder)

Tibia/Fibula

2,141

Closed fracture of carpal bone (disorder)

Forearm

1,993

Closed Monteggia's fracture (disorder)

Elbow

102

Closed Galeazzi fracture (disorder)

Forearm

65

Closed fracture of distal end of radius (disorder)

Forearm

23

Percentage of fractures with a follow-up appointment

Proportion of face-to-face vs virtual follow-up appointments

Percentage of face-to-face and virtual follow-up appts

Percentage of fractures manipulated in the ED

Percentage of fractures manipulated in theatre

Proportion of fractures manipulated in ED vs theatre

Percentage of fractures referred for physiotherapy

Percentage of fractures with a X-ray recorded in the ED

Percentage with follow-up by trust (2022/23)

<ScaleContinuousPosition>
 Range:  
 Limits:    0 --    1

by type

Percentage manipulation in theatre by trust (2022/23)

<ScaleContinuousPosition>
 Range:  
 Limits:    0 --    1

Percentage manipulation in ED by trust (2022/23)

<ScaleContinuousPosition>
 Range:  
 Limits:    0 --    1